Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1985 Aug;202(2):162–165. doi: 10.1097/00000658-198508000-00005

Is there an association between failed antireflux procedures and delayed gastric emptying?

G J Maddern, G G Jamieson, B E Chatterton, P J Collins
PMCID: PMC1250869  PMID: 4015221

Abstract

Recurrence of gastroesophageal reflux symptoms following antireflux surgery is a difficult clinical problem. Sixteen patients (6 men, 10 women; median age 59; range 33-75 years) with a positive endoscopy or pH-probe-assessed acid reflux and recurrence of reflux symptoms following a fundoplication underwent radionuclide solid and liquid gastric emptying studies. The median time between operation and gastric emptying study was 39 months (range 13-89 months). A control group of 21 patients (10 men, 11 women; median age 47; range 19-72 years) who had undergone a standard fundoplication was similarly studied 6 months following surgery. The per cent of solid remaining at 100 minutes in the stomach had a median value of 43% (range 5-89) in the control group. This was significantly less (p less than 0.0001) than in the failed operative group (median 66%, range 27-100). Similarly, the time taken for 50% of the liquid to leave the stomach had a median value of 13 minutes (range 8-27) in the control group; a value significantly less (p less than 0.01) than the failed operative group (median 18.5 min, range 2-60). It is not known whether the delayed emptying in the failed operative group is responsible for the failure of the antireflux surgery. However, delay in gastric emptying either before or after surgery may be of value in predicting patients likely to have poor outcomes.

Full text

PDF
162

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bushkin F. L., Neustein C. L., Parker T. H., Woodward E. R. Nissen fundoplication for reflux peptic esophagitis. Ann Surg. 1977 Jun;185(6):672–677. doi: 10.1097/00000658-197706000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Carlberger G. Gastric emptying of a fluid test meal in healthy volunteers and patients with duodenal ulcer before and after selective proximal vagotomy. Scand J Gastroenterol Suppl. 1975;35:45–47. [PubMed] [Google Scholar]
  3. Collins P. J., Horowitz M., Cook D. J., Harding P. E., Shearman D. J. Gastric emptying in normal subjects--a reproducible technique using a single scintillation camera and computer system. Gut. 1983 Dec;24(12):1117–1125. doi: 10.1136/gut.24.12.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Demeester T. R., Johnson L. F., Kent A. H. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg. 1974 Oct;180(4):511–525. doi: 10.1097/00000658-197410000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ellis F. H., Jr, El-Kard M. F., Gibb S. P. The effect of fundoplication on the lower esophageal sphincter. Surg Gynecol Obstet. 1976 Jul;143(1):1–5. [PubMed] [Google Scholar]
  6. Goodall R. J., Temple J. G. Effect of Nissen fundoplication on competence of the gastro-oesophageal junction. Gut. 1980 Jul;21(7):607–613. doi: 10.1136/gut.21.7.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Henderson R. D. Nissen hiatal hernia repair: problems of recurrence and continued symptoms. Ann Thorac Surg. 1979 Dec;28(6):587–593. doi: 10.1016/s0003-4975(10)63181-5. [DOI] [PubMed] [Google Scholar]
  8. Herrington J. L., Jr, Meacham P. W., Hunter R. M. Gastric ulceration after fundic wrapping. Vagal nerve entrapment, a possible causative factor. Ann Surg. 1982 May;195(5):574–581. doi: 10.1097/00000658-198205000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hill L. D., Ilves R., Stevenson J. K., Pearson J. M. Reoperation for disruption and recurrence after Nissen fundoplication. Arch Surg. 1979 Apr;114(4):542–548. doi: 10.1001/archsurg.1979.01370280196033. [DOI] [PubMed] [Google Scholar]
  10. Jamieson G. G., Duranceau A. What is a Nissen fundoplication? Surg Gynecol Obstet. 1984 Dec;159(6):591–593. [PubMed] [Google Scholar]
  11. Kiroff G. K., Maddern G. J., Jamieson G. G. A study of factors responsible for the efficacy of fundoplication in the treatment of gastro-oesophageal reflux. Aust N Z J Surg. 1984 Apr;54(2):109–112. doi: 10.1111/j.1445-2197.1984.tb06699.x. [DOI] [PubMed] [Google Scholar]
  12. Leonardi H. K., Crozier R. E., Ellis F. H., Jr Reoperation for complications of the Nissen fundoplication. J Thorac Cardiovasc Surg. 1981 Jan;81(1):50–56. [PubMed] [Google Scholar]
  13. Little A. G., DeMeester T. R., Kirchner P. T., O'Sullivan G. C., Skinner D. B. Pathogenesis of esophagitis in patients with gastroesophageal reflux. Surgery. 1980 Jul;88(1):101–107. [PubMed] [Google Scholar]
  14. Maddern G. J., Jamieson G. G. Fundoplication enhances gastric emptying. Ann Surg. 1985 Mar;201(3):296–299. doi: 10.1097/00000658-198503000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McCallum R. W., Fink S. M., Lerner E., Berkowitz D. M. Effects of metoclopramide and bethanechol on delayed gastric emptying present in gastroesophageal reflux patients. Gastroenterology. 1983 Jun;84(6):1573–1577. [PubMed] [Google Scholar]
  16. Papp J. P. Determination of the lower esophageal sphincter pressure in patients having a Nissen or Belsey fundoplication. Am J Gastroenterol. 1979 Feb;71(2):154–157. [PubMed] [Google Scholar]
  17. Washer G. F., Gear M. W., Dowling B. L., Gillison E. W., Royston C. M., Spencer J. Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis. Br J Surg. 1984 Mar;71(3):181–184. doi: 10.1002/bjs.1800710303. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES